Healthcare Provider Details

I. General information

NPI: 1811867179
Provider Name (Legal Business Name): LORI RUGG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

631 OLD SCHOOL HOUSE DR
SPRINGFIELD PA
19064-1543
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-1928
  • Fax:
Mailing address:
  • Phone: 856-430-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP033546
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: